Shah Meera, Reveles Kelly, Moote Rebecca, Hand Elizabeth, Kellogg Iii Dean, Attridge Rebecca L, Maselli Diego J, Gutierrez G Christina
Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.
Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.
Open Forum Infect Dis. 2023 Mar 3;10(3):ofad062. doi: 10.1093/ofid/ofad062. eCollection 2023 Mar.
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a potential complication in critically ill COVID-19 patients. Corticosteroids are standard of care for hospitalized COVID-19 patients but carry an increased risk of secondary infections including CAPA. The objective of this study was to evaluate if duration of corticosteroid therapy ≤10 days versus >10 days affects the risk of developing CAPA.
This was a retrospective cohort study of adult patients with severe COVID-19 pneumonia requiring mechanical ventilation who received at least 3 days of corticosteroid treatment. Incidence of CAPA and secondary outcomes were compared using appropriate bivariable analyses. Steroid duration was evaluated as an independent predictor in a logistic regression model.
A total of 278 patients were included (n = 169 for ≤10 days' steroid duration; n = 109 for >10 days). CAPA developed in 20 of 278 (7.2%) patients. Patients treated with >10 days of corticosteroid therapy had significantly higher incidence of CAPA (11.9% vs 4.1%; = .0156), and steroid duration >10 days was independently associated with CAPA (odds ratio, 3.17 [95% confidence interval, 1.02-9.83]). Secondary outcomes including inpatient mortality (77.1% vs 43.2%; < .0001), mechanical ventilation-free days at 28 days (0 vs 1.5; < .0001), and secondary infections (44.9% vs 28.4% = .0220) were worse in the >10 days cohort.
Corticosteroid treatment >10 days in critically ill COVID-19 patients is associated with an increased risk of CAPA. Patients may require corticosteroids for reasons beyond COVID-19 and clinicians should be cognizant of risk of CAPA with prolonged courses.
2019冠状病毒病（COVID-19）相关肺曲霉病（CAPA）是危重症COVID-19患者的一种潜在并发症。皮质类固醇是住院COVID-19患者的标准治疗药物，但会增加包括CAPA在内的继发感染风险。本研究的目的是评估皮质类固醇治疗持续时间≤10天与>10天是否会影响发生CAPA的风险。
这是一项对需要机械通气的重症COVID-19肺炎成年患者进行的回顾性队列研究，这些患者接受了至少3天的皮质类固醇治疗。使用适当的双变量分析比较CAPA的发生率和次要结局。在逻辑回归模型中评估类固醇治疗持续时间作为独立预测因素。
共纳入278例患者（类固醇治疗持续时间≤10天的有169例；>10天的有109例）。278例患者中有20例（7.2%）发生了CAPA。接受皮质类固醇治疗>10天的患者发生CAPA的发生率显著更高（11.9%对4.1%；P = 0.0156），且类固醇治疗持续时间>10天与CAPA独立相关（比值比，3.17[95%置信区间，1.02 - 9.83]）。在>10天的队列中，包括住院死亡率（77.1%对43.2%；P < 0.0001）、28天时无机械通气天数（0对1.5；P < 0.0001）和继发感染（44.9%对28.4%，P = 0.0220）等次要结局更差。
危重症COVID-19患者接受皮质类固醇治疗>10天与发生CAPA的风险增加相关。患者可能因COVID-19以外的原因需要使用皮质类固醇，临床医生应认识到疗程延长会增加CAPA的风险。
